1 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
2 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
National Food, Nutrition,
and Physical Activity
Survey of the Portuguese
General Population,
IAN-AF 2015-2016
Summary of Results
3 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Title: National Food, Nutrition, and Physical Activity Survey of the Portuguese General
Population 2015-2016: Summary of Results
Authors: Carla Lopes, Duarte Torres, Andreia Oliveira, Milton Severo, Violeta Alarcão,
Sofia Guiomar, Jorge Mota, Pedro Teixeira, Sara Rodrigues, Liliane Lobato, Vânia
Magalhães, Daniela Correia, Catarina Carvalho, Andreia Pizarro, Adilson Marques, Sofia
Vilela, Luísa Oliveira, Paulo Nicola, Simão Soares, Elisabete Ramos.
Edition: University of Porto
ISBN: 978-989-746-202-3
All rights reserved. This text cannot be
reproduced, displayed, published or
redistributed without the prior permission of the authors.
IAN-AF 2015-2016 (
www.ian-af.up.pt
)
This report is based on information gathered in the scope of the National Food,
Nutrition, and Physical Activity Survey of the Portuguese General Population, IAN-AF
2015-2016, developed by a Consortium that has the University of Porto as Promoter.
The IAN-AF had funding from the Financial Mechanism of Europe granted by Iceland,
Liechtenstein and Norway through the EEA-Grants Program - Public Health Initiatives
(PT06 - 000088SI3).
IAN-AF had the institutional support of General Directorate of Health, Central
Administration of Health Systems, Regional Health Administrations, Regional
Secretariat for Health of Azores and Madeira and European Food Safety Authority.
Citation suggestion: Lopes C, Torres D, Oliveira A, Severo M, Alarcão V, Guiomar S, Mota J,
Teixeira P, Rodrigues S, Lobato L, Magalhães V, Correia D, Carvalho C, Pizarro A, Marques A, Vilela S, Oliveira L, Nicola P, Soares S, Ramos E. National Food, Nutrition, and Physical Activity Survey of the Portuguese General Population, IAN-AF 2015-2016: Summary of Results, 2018. ISBN: 978-989-746-202-3. Available at: www.ian-af.up.pt.
4 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
CONSORCIUM
Faculty of Medicine, University of Porto (Carla Lopes, Milton Severo, Andreia Oliveira) Institute of Public Health, University of Porto (Elisabete Ramos, Sofia Vilela)
Faculty of Nutrition and Food Sciences, University of Porto (Duarte Torres, Sara Rodrigues) National Institute of Health Doutor Ricardo Jorge (INSA) (Sofia Guiomar, Luísa Oliveira) AIDFM - Faculty of Medicine, University of Lisbon (Paulo Nicola, Violeta Alarcão) Faculty of Sports, University of Porto (Jorge Mota)
Faculty of Human Kinetics, University of Lisbon (Pedro J. Teixeira) SilicoLife (Simão Soares)
Faculty of Medicine, University of Oslo, Norway (Lene Andersen)
INSTITUTIONAL SUPPORT
General Directorate of Health
Central Administration of Health Systems Regional Health Administrations
Regional Secretariat for Health of Azores and Madeira European Food Safety Authority
FUNDINGS
Inquérito Alimentar Nacional e de Atividade Física, IAN-AF 2015-2016 | Relatório de resultados
Index
List of tables ... 6 List of figures ... 8 1. Food Consumption ... 14 1.1 Food Consumption ... 151.1.1. Adherence to Food Recommendations ... 20
1.2 Consumption of Non-alcoholic Beverages ... 25
1.3 Consumption of Alcoholic Beverages ... 29
2.Nutrients Intake ... 34
2.1. Energy and Macronutrients ... 35
2.2. Alcohol and Water ... 43
2.3. Micronutrients ... 46
2.4. Contribution of Food Groups to Nutritional Intake ... 50
3. Eating Behaviours ... 56
3.1. Dietary Supplements ... 57
3.2. Breastfeeding and Weaning ... 59
3.3. Consumption of Organic Food ... 61
3.4. Meal Patterns ... 62
3.5. Special Diets ... 62
4. Food Insecurity ... 64
5. Adherence to the Mediterranean Dietary Pattern ... 71
6. Physical Activity ... 78
6.1. Levels of Physical Activity ... 79
6.2. Active Outdoor Play... 83
6.3. Practice of Structured Physical Activity ... 85
6.4. Types of Physical Activity... 92
6.5. Sedentary Choices... 92
6.6. TV Viewing Time ... 96
7. Anthropometric Evaluation ... 100
6 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
List of tables
Table 1.1. Usual intake of some food groups in edible grams per day, at national level and among consumers, weighted for the Portuguese population distribution. ... 16 Table 1.2. Prevalence of inadequate consumption of processed meat and red meat* (>50g/day and >100g/day, respectively), at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 24 Table 1.3. Usual intake of some non-alcoholic beverages per day, at national level and among consumers, weighted for the Portuguese population distribution. ... 26 Table 2.1. Daily intake of the total energy and macronutrients, for the all population and by sex (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 36 Table 2.2. Daily intake of total energy, macronutrients and fibre, by age group (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 37 Table 2.3. Daily intake of total energy and macronutrients by educational level (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 40 Table 2.4. Prevalence of inadequate intake of macronutrients, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 42 Table 2.5. Daily intake of alcohol and water, at national level and by sex (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 43 Table 2.6. Daily intake of alcohol and water, according to the age group, educational level and region, by sex (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 45 Table 2.7 – Prevalence of inadequacy of alcohol and water, at national level and by sex and age group (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 46 Table 2.8. Daily intake of micronutrients (IAN-AF 2015-2016), adjusted for the within-person variability of dietary intake, at national level and by sex, weighted for the distribution of the Portuguese population. ... 47 Table 2.9. Daily intake of micronutrients (IAN-AF 2015-2016), adjusted for the within-person variability of dietary intake, by age group, weighted for the Portuguese population distribution... 48 Table 2.10. Prevalence of inadequacy in the intake of micronutrients (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 49 Table 3.1. Prevalence of different types of food/nutritional supplements intake, by individuals who used it, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 58 Table 3.2. Prevalence of folic acid supplementation before pregnancy and during the first trimester of pregnancy (IAN-AF 2015-2016). ... 58
7 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Table 3.3. Prevalence of breastfeeding, artificial feeding and weaning characteristics. ... 60 Table 3.4. Prevalence of individuals who consume certified organic products, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 61 Table 3.5. Consumption frequency of certified organic products (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 61 Table 6.1 Weekly frequency of regular practice of structured physical activity, as sports and/or leisure, in children and adolescents between 3 and 14 years of age, by region (NUTS II), weighted for the Portuguese population distribution. ... 91
8 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
List of figures
Figure 1.1. Mean consumption of food group and subgroup, expressed in edible grams per day, at national level and by age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 17 Figure 1.2. Mean consumption of “Fats and oils” subgroups, expressed in edible grams per day, at national level and by age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 18 Figure 1.3. Mean consumption of food group and subgroup expressed in edible grams per day, at national level and by educational level (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 19 Figure 1.4. Comparison between the Portuguese Food Wheel Guide recommendations and the estimated food consumption for the Portuguese population (IAN-AF 2015-2016). ... 20 Figure 1.5. Prevalence of inadequate consumption of fruit and vegetables (<400 g/day, non-edible), at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 22 Figure 1.6. Prevalence of inadequate consumption of fruit and vegetables (<400 g/day, edible), at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 22 Figure 1.7. Spatial distribution of the prevalence of inadequate consumption of fruit and vegetables (<400 g/day, non-edible), by region NUTS II, weighted for the Portuguese population distribution. ... 23 Figure 1.8. Spatial distribution of the prevalence of inadequate consumption of red meat* (>100g/day, edible), by region NUTS II, weighted for the Portuguese population distribution. ... 25 Figure 1.9. Water consumption (millilitres per day), at national level and by age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 26 Figure 1.10. Consumption of some types of beverages, expressed in grams per day, at national level and by age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 27 Figure 1.11. Prevalence of daily consumption of soft drinks and nectars (≥220 g/day, at least one serving), at national level, weighted for the Portuguese population distribution. ... 28 Figure 1.12. Prevalence of daily consumption of soft drinks (≥220 g/day, at least one serving), at national level, weighted for the Portuguese population distribution. ... 28 Figure 1.13. Consumption of some types of beverages, expressed in grams per day, at national level and by educational level (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 29 Figure 1.14. Median consumption of some types of beverages expressed in grams per day (main axis) and the consumption frequency (secondary axis), by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 30 Figure 1.15. Total mean consumption of wine and consumption only among consumers, expressed in grams per day, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 30
9 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Figure 1.16. Median consumption of some types of beverages expressed in grams per day (main axis) and the consumption frequency (secondary axis), by sex and educational level (IAN-AF 2015-2016), weighted for the Portuguese
population distribution. ... 31
Figure 1.17. Consumption of alcoholic beverages, based on the Food Propensity Questionnaire, for individuals aged above 14 year olds, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 32
Figure 2.1. Contribution in percentage for the total energy intake of macronutrients (considering the contribution of alcohol), at national level, by sex and by age group (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 38
Figure 2.2. Contribution in percentage for the total energy intake of macronutrients and alcohol of individuals aged 15 years-old or more, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 38
Figure 2.3. Spatial distribution (by NUTS II region) of the mean energy intake (kcal / day) (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 39
Figure 2.4. Prevalence of (in)adequacy of macronutrient intake, by sex (IAN-AF 205-2016), weighted for the distribution of the Portuguese population. ... 41
Figure 2.5. Mean daily intake of alcohol, in grams per day, in individuals aged 15 year-old or over, by sex and age group (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population ... 43
Figure 2.6 Mean daily intake of alcohol, in grams per day, in individuals aged 15 year-old and over who consumes alcohol, by sex and age group (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population. ... 44
Figure 2.7. Contribution of food subgroups to the daily total energy intake (%). ... 51
Figure 2.8. Contribution of food subgroups to the daily intake of saturated fatty acids (%). ... 51
Figure 2.9. Contribution of food subgroups to the daily intake of free sugars (%). ... 52
Figure 2.10. Contribution of food subgroups to the daily intake of sodium (%). ... 52
Figure 3.1. Prevalence of food/nutritional supplements use in the previous 12 months (previous month for children) at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 57
Figure 3.2. Living area (NUTS II) and parental educational level of children aged 3-36 months, weighted for the Portuguese population distribution. ... 59
Figure 3.3. Prevalence of meal consumption at national level and by age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 62
Figure 4.1. Prevalence of classes of Food Insecurity at national level, weighted for the Portuguese population distribution. ... 65
10 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Figure 4.2. Spatial distribution of the prevalence of Food Insecurity (moderate and severe) by region NUTS II, weighted for the Portuguese population distribution. ... 66 Figure 4.3. Prevalence of Food Insecurity (moderate and severe), by type of household and educational level (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 67 Figure 4.4. Prevalence classes of Food Insecurity categories, by household income levels (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 67 Figure 4.5. Prevalence of reporting food insecurity indicators, globally and by categories of Food Insecurity, weighted for the Portuguese population distribution. ... 69 Figure 5.1. Prevalence of adherence to the Mediterranean Dietary Pattern in the adult population, without adjustment for the within-person variability of dietary intake (methodology 1), at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 73 Figure 5.2. Prevalence of adherence to the Mediterranean Dietary Pattern in the adult population, adjusted for the within-person variability of dietary intake (methodology 2), at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 73 Figure 5.3. Spatial distribution (by NUTS II region) of the prevalence of high adherence to the Mediterranean Dietary Pattern in the adult population, by region (NUTS II), weighted for the Portuguese population distribution. ... 74 Figure 5.4. Prevalence of high adherence to the Mediterranean Dietary Pattern in the adult population, by level of food (in)security and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 75 Figure 5.5. Prevalence of high adherence to the Mediterranean Dietary Pattern in the adult population, by physical activity level (IPAQ) and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 75 Figure 5.6. Prevalence of high adherence to the Mediterranean Dietary Pattern in the adult population, by self-reported health status and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 76 Figure 6.1. Prevalence of physical activity levels “Active”, “Moderately Active” and “Sedentary” in people aged between 15 and 84 years of age, at national level and by sex, weighted for the Portuguese population distribution. 79 Figure 6.2. Prevalence of physical activity levels “Active” in teenagers and young adults, adults and elderly, weighted for the Portuguese population distribution. ... 80 Figure 6.3. Prevalence of physical activity levels “Active” and “Sedentary” by region NUTS II (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 81 Figure 6.4. The prevalence of 60 minutes/day of moderate/vigorous physical activity (≥3METS/hour), at national level, by sex and age groups (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 81 Figure 6.5 Spatial distribution (by NUTS II region) of prevalence of 60 minutes/day of moderate/vigorous physical activity (≥3METS/hour), weighted for the Portuguese population distribution. ... 82
11 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Figure 6.6. Prevalence of active outdoor play, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 83 Figure 6.7. Prevalence of active outdoor play by region (NUTS II), weighted for the Portuguese population distribution. ... 84 Figure 6.8. Prevalence of active outdoor play by parents’ education (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 84 Figure 6.9. Prevalence of regular practice of structured physical activity, as sports and/or leisure, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 85 Figure 6.10. Spatial distribution (by NUTS II region) of prevalence of regular practice of structured physical activity, as sports and/or leisure, weighted for the Portuguese population distribution. ... 86 Figure 6.11. Prevalence of regular practice of structured physical activity, as sports and/or leisure, by educational level (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 87 Figure 6.12. Weekly frequency of regular practice of structured physical activity, as sports and/or leisure, weighted for the Portuguese population distribution. ... 87 Figure 6.13. Prevalence of regular practice of structured physical activity, as sports and/or leisure, in children and adolescents between 3 and 14 years of age, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 88 Figure 6.14. Prevalence of regular practice of structured physical activity, as sports and/or leisure, in children and adolescents between 3 and 14 years of age, by region (NUTS II), weighted for the Portuguese population distribution. ... 89 Figure 6.15. Prevalence of regular practice of structured physical activity, as sports and/or leisure, in children and adolescents between 3 and 14 years of age, by parents’ education (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 89 Figure 6.16. Weekly frequency of regular practice of structured physical activity, as sports and/or leisure, in children and adolescents between 3 and 14 years of age, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 90 Figure 6.17. Weekly frequency of regular practice of structured physical activity, as sports and/or leisure, in children and adolescents between 3 and 14 years of age, by parents’ education (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 91 Figure 6.18. Prevalence of “never”/ “rarely” for using the stairs rather than the elevator or escalator, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 93 Figure 6.19. Prevalence of “never”/ “rarely” for using the stairs rather than the elevator or escalator, at national level and by regions (NUTS II), weighted for the Portuguese population distribution... 93
12 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Figure 6.20. Prevalence of “never”/ “rarely” for taking active breaks, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 94 Figure 6.21. Prevalence of “never”/ “rarely” for taking active breaks, at national level and by regions (NUTS II), weighted for the Portuguese population distribution. ... 94 Figure 6.22 Average daily time, in hours, spent in sedentary behaviours, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 95 Figure 6.23 Average daily time, in hours, spent in sedentary behaviours, by region (NUTS II), weighted for the Portuguese population distribution. ... 95 Figure 6.24. Prevalence of watching 2 or more hours/day of television, during weekdays and weekends, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 96 Figure 6.25. Prevalence of watching 2 or more hours/day of television, during weekdays and weekends, by region (NUTS II), weighted for the Portuguese population distribution. ... 97 Figure 6.26. Prevalence of watching 2 or more hours/day of television, during weekdays and weekends, by parents’ education (NUTS II), weighted for the Portuguese population distribution. ... 97 Figure 7.1. Prevalence of obesity, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 101 Figure 7.2 Prevalence of pre-obesity, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 102 Figure 7.3. Prevalence of obesity and pre-obesity across age groups, weighted for the Portuguese population distribution ... 102 Figure 7.4. Prevalence of obesity, by educational level (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 103 Figure 7.5. Prevalence of pre-obesity, by educational level (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 103 Figure 7.6. Spatial distribution (by NUTS II region) of the prevalence of pre-obesity and obesity, weighted for the Portuguese population distribution. ... 104 Figure 7.7. Prevalence of increased risk based on waist circumference, in the adult population, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 105 Figure 7.8. Prevalence of substantially increased risk of metabolic complications based on waist-hip ratio, in the adult population, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 105
13 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Figure 7.9. Prevalence of substantially increased risk of metabolic complications based on waist circumference, in the adult population, at national level, by educational level and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 106 Figure 7.10. Prevalence of substantially increased risk of metabolic complications based on waist-hip ratio, in the adult population, at national level, by educational level and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. ... 106 Figure 7.11. Spatial distribution (by NUTS II region) of prevalence of substantially increased risk of metabolic complications based on waist-hip ratio, in the adult population, at national level and by region (NUTS II), weighted for the Portuguese population distribution. ... 107
14 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
1.
Food
15 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
The IAN-AF 2015-2016 reported the consumption of 2479 food items, including foods, beverages and 1696 food recipes. Each food item was grouped into categories (described in the Appendix 1) and the analysis proceeded according to the food groups with a higher consumption in Portugal.
The food consumption data was collected through a two 24-hours recall (two diaries in children), adjusted for the within-person variability of dietary intake and consumption frequency (for less frequent food items), considering only the conversion of raw and cooked foods to edible portions. In some analyses, the quantification of raw foods was used in order to be comparable with other studies.
The food groups “Soups”, “Sweets, cakes and biscuits” and “Salty snacks and pizzas” result from aggregated methodology that comprises the respective food items and recipes while the other food groups result from a disaggregation of food items and recipes.
This chapter presents some of the main results regarding the consumption of food and beverages. Methodological notes can be found in the Appendix 1.
1.1 Food Consumption
Table 1.1 and figure 1.1 compile information related with the food consumption at national level and stratified by age group.
The mean consumption of "Fruit, vegetables and pulses" by the Portuguese population is 312 g/day and it corresponds to about 153 g/day of vegetables, 131g/day of fresh fruit and 18 g/day of pulses. The elderly consume significantly more of these foods, particularly fresh fruit. On the contrary, inadequate consumption of fruit, vegetables and pulses is more prevalent among children and adolescents, with the latter consuming significantly less fresh fruit and vegetables (97 g/day and 133 g/day, respectively).
The mean consumption of soups by the Portuguese population is about 154 g/day. Children and the elderly have a higher consumption of soups (247 g/day, 199 g/day respectively), while adults have the lowest (132 g/day).
16 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
The Portuguese population consumes about 254 g/day of dairy products, mainly milk (167 g/day). Children and adolescents are the individuals with the highest level of consumption, followed by the elderly. Adults consume significantly less milk than the other age groups. As for yoghurt and other fermented milks, children are the main consumers (mean of 87 g/day) while the elderly have the lowest intake.
Relatively to the "Cereals, cereal products and starchy tubers" food group, adolescents stand out as the age group with the highest consumption (323 g/day). However, the elderly have the highest consumption of bread, toast, potatoes and other tubers.
The consumption of breakfast cereals and cereal bars is higher in children and adolescents, with the latter consuming more than twice of the mean consumption at the national level (20 g/day vs. 9 g/day, respectively).
Table 1.1. Usual intake of some food groups in edible grams per day, at national level and among consumers, weighted for the Portuguese population distribution.
Total % Days of consumption Among consumers Mean g/day Median (P25-P75) g/day Mean g/day Median (P25-P75) g/day
Fruit, vegetables and legumes 312.1 294.9
(207.7-397.8) >95% 312.1 294.9 (207.7-397.8) Soups* 153.9 132.9 (60.1-223.7) 46.4% 320.9 307.0 (239.1-307.0) Dairy 253.5 219.8 (129.7-340.2) >95% 253.5 219.8 (129.7-340.2) Cereals, cereal products and
starchy tubers 306.1
293.3
(220.3-378.0) >95% 306.1
293.3 (220.3-378.0) Meat, fish and eggs 174.3 163.2
(116.0-220.7) >95% 174.3
163.2 (116.0-220.7) Fats and oils 20.6 19.1
(13.4-26.2) >95% 20.6
19.1 (13.4-26.2) Sweets, cakes and biscuits* 69.7 54.3
(30.6-91.1) 93.1% 83.7
67.0 (18.1-67.0) Salty snacks and pizzas* 20.2 13.0
(4.1-28.8) 10.4% 135.7
129.2 (99.0-165.4)
P25-P75: percentile 25-75; * The food group “Soups” (any kind), “Sweets, cakes and biscuits” and “Salty snacks and pizzas” include recipes and isolated food items.
17 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
In all age groups, meat is consumed in a greater quantity than fish. However, the elderly have a slightly similar intake rates of these foods, whereas adolescents have the greatest disparity among meat and fish consumption (130 g/day vs. 33 g/day). Overall, eggs have a small contribution in the Portuguese diet.
It is important to highlight the high percentage of "Sweets, cakes and biscuits" consumption (93.1%) by adolescents (90 g/day).
* The food groups “Soups”, “Sweets, cakes and biscuits” and “Salty snacks and pizzas” include recipes, apart the isolated food items.
Figure 1.1. Mean consumption of food group and subgroup, expressed in edible grams per day, at national level and by age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. 17 46 17 38 156 199 20 171 166 28 69 19 63 149 132 19 153 129 42 77 15 72 250 151 12 133 97 33 52 9 87 267 247 8 134 109 28 64 18 61 167 154 18 153 131 0 100 200 300 Pasta Rice and other grains Cheese Yoghurt and other fermented milks Milk Soups* Pulses Vegetables Fresh fruit g/day
Total Children Adolescents Adults Elderly
8 50 15 46 80 4 113 99 23 73 17 44 129 9 104 85 31 90 14 33 130 20 86 82 10 65 10 25 79 11 54 81 20 70 16 42 117 9 100 100 0 100 200 300 Salty snacks and pizzas* Sweets, cakes and biscuits Eggs Fish Meat Breakfast cereals and cereal bars Bread and toasts Potatos and other starchy tubers
g/day
18 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Relatively to the group of "Fats and oils", olive oil stands out as the subgroup with the highest consumption, followed by butter and vegetable oil (figure 1.2). Comparatively to adults, adolescents have greater vegetable oil consumption than the elderly, olive oil is less consumed by children and adolescents and butter is less consumed by the elderly.
Figure 1.2. Mean consumption of “Fats and oils” subgroups, expressed in edible grams per day, at national level and by age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution.
Our findings suggest that more educated individuals consume significantly more vegetables, yoghurt and fermented milk, food items from the groups "Sweets, cakes and biscuits", "Salty snacks and pizzas" and less food items from the group "Cereals, cereal products and starchy tubers" than the less educated individuals (Figure 1.3).
2 3 12 2 2 4 11 3 2 4 10 3 1 2 9 1 2 4 11 2 0 2 4 6 8 10 12 14 Margarines and minarines Butter Olive oil Vegetable oils g/day
19 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
* The food groups “Soups”, “Sweets, cakes and biscuits” and “Salty snacks and pizzas” include recipes, apart the isolated food items.
Figure 1.3. Mean consumption of food group and subgroup expressed in edible grams per day, at national level and by educational level (IAN-AF 2015-2016), weighted for the Portuguese population distribution.
Considering the analyses by geographic region, the group "Dairy" is mostly consumed in the Azores region, which has a mean consumption of 308 g/day as well as higher percentiles of the consumption distribution. In the other regions, the results for the mean consumption of food items in the group "Dairy" are as follows: North: 262 g/day; Centre: 253 g/day; Lisbon MA: 242
26 78 45 109 11 100 79 26 59 76 159 164 15 170 154 20 75 44 120 9 103 85 25 66 63 172 148 18 153 133 14 59 36 118 8 100 94 30 71 48 171 154 19 141 110 0 50 100 150 200 Salty snacks and pizzas* Sweets, cakes and biscuits Fish Meat Breakfast cereals and cereal bars Bread and toasts Potatos and other starchy tubers
Pasta Rice and other grains Yoghurt and other fermented milks Milk Soups* Pulses Vegetables Fresh fruit g/day
20 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
g/day; Alentejo: 268 g/day; Algarve: 247 g/day; Madeira: 224 g/day. These data indicate that, at a subgroup level, milk is mostly consumed in Azores (227 g/day).
The distribution of the consumption of bread and toast subgroup ("Cereals, cereal products and starchy tubers" group) is different across regions. This subgroup has the lowest consumption in Madeira and Azores (79.7 g/day and 94.8 g/day, respectively) and in Lisbon MA (95.0 g/day). Alentejo is the region with a higher consumption of this food subgroup (136.5 g/day).
1.1.1. Adherence to Food Recommendations
Portuguese Food Wheel Guide
Figure 1.4 compares the food consumption at the national level and its accordance to the Portuguese Food Wheel Guide, considering only the consumption of the food groups presented in this guide.
The results indicate that the "Meat, fish and eggs" food group consumption is 12% higher relatively to the recommendations, as well as the consumption of “Dairy” (6% higher) and “Cereals, cereal products and starchy tubers” (1% higher). On the other hand, the consumption of "Fruit" (-7%), "Legumes" (-2%) and "Cereals, derivatives and tubers" (-1%) is above the recommendations. The consumption of "Oils and Fats" by the Portuguese population corresponds to the recommendations set by the guide.
Figure 1.4. Comparison between the Portuguese Food Wheel Guide recommendations and the estimated food consumption for the Portuguese population (IAN-AF 2015-2016).
21 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Considering the total amount of food and beverages consumed by the Portuguese population (i.e. not included in the Food Wheel, like sweets, snacks, alcoholic beverages, but not including water), the percentage of consumption of each food group of the Portuguese population is as follows: 20% of “Cereals, cereal products and starchy tubers”, 17% of “Dairy”,12% of “Meat, fish and eggs”, 10% of “Vegetables”, 9% of “Fruit”, 1% of “Pulses” and 1% of “Oils and fats”. Overall, the foods and beverages not represented in the Portuguese Food Wheel Guide represent 29% of the national consumption, with “Non-alcoholic beverages” (except water) contributing with 16%, “Alcoholic beverages” with 7%, “Sweets, cakes and biscuits” with 4% and “Salty snacks and pizzas” with 1%.
Fruit and vegetables
The consumption of fruit and vegetables is one of the most used indicators in the world to assess diet quality. The World Health Organization recommends the consumption of at least 400 g/day of these foods (equivalent to 5 or more portions per day) (1).
Considering exclusively the edible portion of "Fruit, vegetables and legumes", the mean daily intake is 312 g/day. Disparities among age groups are highlighted, such as a lower consumption of vegetables by children and fruit by adolescents.
Considering the consumption of purchased fruit and vegetables (this methodology is frequently applied to other populations), the prevalence of individuals who do not adhere to the recommended daily intake of at least 400 g/day is 56% (figure 1.5). The inadequacy of fruit and vegetables consumption is higher in adolescents (78%), children (72%) and lower in the elderly (40%). Figure 1.6 shows the prevalence of fruit and vegetables consumption <400 g/day, considering the edible portions. According to this approach, the prevalence of inadequacy is even higher.
22 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Figure 1.5. Prevalence of inadequate consumption of fruit and vegetables (<400 g/day, non-edible), at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution.
Figure 1.6. Prevalence of inadequate consumption of fruit and vegetables (<400 g/day, edible), at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution.
At a regional level (NUTS II) (Figure 1.7), the disparities in the prevalence of inadequate fruit and vegetables consumption, have a higher magnitude in Madeira and Azores (70%).
56% 72% 78% 57% 40% 60% 74% 80% 61% 44% 53% 71% 75% 53% 36% 0% 20% 40% 60% 80% 100% Total (3-84 years) Children (3-9 years) Adolescents (10-17 years) Adults (18-64 years) Elderly (65-84 years)
<400g/day of fruits and vegetables, as purchased
Total Female Male
75% 87% 91% 76% 63% 79% 89% 93% 80% 69% 72% 86% 88% 72% 57% 0% 20% 40% 60% 80% 100% Total (3-84 years) Children (3-9 years) Adolescents (10-17 years) Adults (18-64 years) Elderly (65-84 years)
<400g/day of fruits and vegetables, edible
23 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Figure 1.7. Spatial distribution of the prevalence of inadequate consumption of fruit and vegetables (<400 g/day, non-edible), by region NUTS II, weighted for the Portuguese population distribution.
Red meat and processed meats
The International Agency for Research on Cancer (IARC) classified processed meats as carcinogenic to humans (group 1) in 2015 (2).
A daily consumption of 50 g of processed meats was associated with an 18% increased risk of colon cancer, while a daily consumption of 100 g of red meat was associated with a 17% risk increase.
Table 1.2 describes the prevalence of daily consumption that exceeds the cut-off points associated with an increased health risk. The daily consumption of processed meat greater than 50 g is done by 6.3% of the population (5.7% in children, 11.6% in adolescents, 7.1% in adults and 1.0% in the elderly), while the consumption of more than 100 g of red meat is observed in 22.5% of the population (16.3% in children, 32.3% in adolescents, 25.5% in adults and 9.0% in the elderly).
24 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Table 1.2. Prevalence of inadequate consumption of processed meat and red meat* (>50g/day and >100g/day, respectively), at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution.
Total (3-84 years) Children (3-9 years) Adolescents (10-17 years) Adults (18-64 years) Elderly (65-84 years) >50 g/day of processed meat (charcuterie)
Total 6.3% 5.7% 11.6% 7.1% 1.0%
Female 2.1% 3.0% 5.8% 2.2% 0.1%
Male 11.9% 6.3% 16.8% 14.0% 2.2%
>100 g/day of red meat*
Total 22.5% 16.3% 32.3% 25.5% 9.0%
Female 8.4% 9.0% 17.7% 9.2% 1.8%
Male 40.2% 19.1% 44.5% 46.7% 18.2%
* Red meat– all types of red meat, processed meat and offals.
At a regional level (figure 1.8), the prevalence of a daily consumption greater than 100g of red meat is higher in the North (27.0%) and MA Lisbon (26.4%). The prevalence of a daily consumption higher than 50g of processed meat is higher in Azores (10.0%).
25 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
* Red meat– all types of red meat, processed meat and offals.
Figure 1.8. Spatial distribution of the prevalence of inadequate consumption of red meat* (>100g/day, edible), by region NUTS II, weighted for the Portuguese population distribution.
1.2 Consumption of Non-alcoholic Beverages
The consumption of non-alcoholic beverages, for the total population and by age group is described in table 1.3 and figures 1.9 and 1.10.
The Portuguese population drinks, on average, less than 1 litre per day of water, considering only the drinking water (excluding the water intrinsic to food or used for cooking purposes). Adults are the age group with the highest consumption of water, corresponding to a mean of 956 mL/day. Adolescents and the elderly have similar consumption to adults. Children are the ones who drink less water, in average less than 500 mL/day (432 mL/day).
26 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Table 1.3. Usual intake of some non-alcoholic beverages per day, at national level and among consumers, weighted for the Portuguese population distribution.
Total % Days of consumption Among Consumers Mean g/day Median (P25-P75) g/day Mean g/day Median (P25-P75) g/day Water* 869.8 784.3 (493.3- 1151.6) >95% 869.8 784.3 (493.3- 1151.6) Tea and infusions 77.0 8.7
(0.1-92.7) 2.8% 377.9 336.4 (211.5-499.3) Coffee 54.9 37.0 (8.7-78.5) 94.4% 73.8 28.9 (7.8-56.1) Natural and 100% fruit juices 22.3 4.5
(0.8-18.4) 7.5% 158.0 75.1 (30.1-178.1) Nectars 20.0 1.1 (0.0-17.7) 0.5% 249.2 236.3 (178.1-306.2) Soft drinks 88.4 33.2 (2.0-135.0) 11.5% 325.3 303.8 (221.4-405.4) P25-P75: percentile 25-75;
*Water- the estimative includes all the drinking water (excludes the water intrinsic to food or used for cooking purposes)
Figure 1.9. Water consumption (millilitres per day), at national level and by age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution.
The Chapter 2 describes the total water intake, including the water intrinsic to food. For that matter, the mean daily consumption of water by the population corresponds to 2.1 litres (2.3 L in adults; 2.0 L in adolescents and elderly and 1.5 L in children).
869.8 432.1 736.7 956.4 780.1 0 200 400 600 800 1000 1200
Total Children Adolescents Adults Elderly
m
L/
da
27 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Soft drinks are the second most consumed beverages in Portugal (88 g/day), frequently consumed by adolescents. Soft drinks and nectars intake is especially high (161 g/day and 38 g/day, respectively) when compared with other age groups (figure 1.9).
Figure 1.10. Consumption of some types of beverages, expressed in grams per day, at national level and by age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution.
The prevalence of daily consumption of soft drinks and nectars (≥220 g/day, at least one serving) in Portugal is 18%. Adolescents are the age group with the highest prevalence (42%; 34% in girls and 51% in boys). Overall, the results reveal that men consume more soft drinks and fruit nectars on a daily basis (at least one serving) when compared with women (26% and 11%, respectively) (figure 1.11). 26 8 13 56 91 100 21 24 66 87 161 38 32 8 22 56 20 21 1 8 88 20 22 55 77 0 20 40 60 80 100 120 140 160 180 Soft Drinks Nectars Natural and 100% fruit juices Coffee Tea and infusions
g/day
28 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Figure 1.11. Prevalence of daily consumption of soft drinks and nectars (≥220 g/day, at least one serving), at national level, weighted for the Portuguese population distribution.
The contribution of soft drinks to this percentage is 14% (34% in adolescents) (figure 1.12). Approximately 25% of the adolescents who consume soft drinks consume at least two servings per day.
Figure 1.12. Prevalence of daily consumption of soft drinks (≥220 g/day, at least one serving), at national level, weighted for the Portuguese population distribution.
18% 22% 42% 19% 3% 11% 21% 34% 10% 2% 26% 23% 51% 28% 4% 0% 10% 20% 30% 40% 50% 60% Total
(3-84 years) (3-9 years)Children (10-17 years)Adolescents (18-64 years)Adults (65-84 years)Elderly
Soft drinks and nectars, ≥220 g/day
Total Female Male
14% 13% 34% 15% 2% 9% 12% 26% 8% 1% 21% 13% 40% 24% 3% 0% 10% 20% 30% 40% Total (3-84 years) Children (3-9 years) Adolescents (10-17 years) Adults (18-64 years) Elderly (65-84 years)
Soft drinks, ≥220 g/day
29 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
The consumption of some sub-groups of non-alcoholic beverages by educational level is shown in figure 1.13. Individuals with a higher educational level consume significantly less soft drinks and nectars, more fresh fruit juices and more 100% fruit juices than less educated individuals.
Figure 1.13. Consumption of some types of beverages, expressed in grams per day, at national level and by educational level (IAN-AF 2015-2016), weighted for the Portuguese population distribution.
The analysis on the consumption of non-alcoholic beverages by region suggests that Azores has the highest consumption of soft drinks (131 g/day) as well as a higher frequency of consumption (27.1%) when compared to other regions.
1.3 Consumption of Alcoholic Beverages
The consumption of alcoholic beverages has a bimodal distribution, due to great disparities among men and women consumption. Consequently, the results are stratified by age group and sex (figure 1.14).
The frequency of alcoholic beverages consumption in men increases with age and is especially higher in the elderly (85%), adults (73%) and lower among adolescents (46%). Women’s frequency of consumption of alcoholic beverages is analogous across all age groups yet slightly lower in older women (37% vs. 43% in adolescents and 45% in adults).
Among consumers, female and male adolescents have similar consumption of alcoholic beverages and differences between sexes are significant in adults and elderly. The mean consumption of the elderly is the highest, both for men (322 g/day) and women (61 g/day).
72 22 28 93 22 22 107 16 17 0 20 40 60 80 100 120 Soft Drinks Nectars Natural and 100% fruit juices g/day
30 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Figure 1.14. Median consumption of some types of beverages expressed in grams per day (main axis) and the consumption frequency (secondary axis), by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution.
In general, wine is the most consumed alcoholic beverage for both men and women, across all age groups. However, when consumed, beer is the alcoholic beverage consumed in higher quantity. (figure 1.15).
Figure 1.15. Total mean consumption of wine and consumption only among consumers, expressed in grams per day, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution. 23 36 61 41 215 322 43% 45% 37% 46% 73% 85% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 0 100 200 300 400 500 600
Adolescents Adults Elderly
Female Male Female Male
26 148 66 219 8 90 245 525 1 2 71 56 1 3 24 47 0 100 200 300 400 500 600
Female Male Female Male
Total Among Consumers
g/
day
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The consumption of alcoholic beverages by educational level has different trends according to sex. Even though, men consume more alcoholic beverages and more frequently, independently of the educational level; as the educational level increases men tend to consume less quantity of alcoholic beverages and consume it less frequently, while women tend to consume more quantity and with higher frequency (figure 1.16).
Figure 1.16. Median consumption of some types of beverages expressed in grams per day (main axis) and the consumption frequency (secondary axis), by sex and educational level (IAN-AF 2015-2016), weighted for the Portuguese population distribution.
Alentejo is the region with the highest alcoholic beverages consumption among men (181 g/day), followed by the Centre region (170 /day). At a subgroup level, the analysis reveals that the consumption of wine is slightly higher in the North (89 g/day) and Centre (88 g/day). Based on the information collected from the Food Propensity Questionnaire (FPQ), the proportion of the population aged 15 year-old or more with a consumption of alcoholic beverages over the last 12 months prior to the interview, by sex and age group, is shown in figure 1.17. About 25% of the individuals consumed alcoholic beverages on a daily basis and 20.9% reported a null consumption in the last 12 months. The frequency of daily consumption is higher in the elderly (41.7%) and adults (22.3%), and null in adolescents. Regarding adolescents, 63.8% of girls and 55.7% of boys reported have never consumed it in the last 12 months before the interview.
26 43 79 244 240 185 39% 46% 48% 78% 75% 70% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 0 100 200 300 400 500
None, 1st and 2nd cycle 3rd cycle and high school Higher education
32 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Figure 1.17. Consumption of alcoholic beverages, based on the Food Propensity Questionnaire, for individuals aged above 14 year olds, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the Portuguese population distribution.
Chapter 2 describes and quantifies the estimates of alcohol intake obtained from the 24-hours dietary recall. Considering the alcohol intake by individuals aged 15 year-old or more and its contribution to the total energy intake, men present higher contribution than women (5.9% vs.2.0%), especially in the elderly age group (9.9% vs. 3.2%). Adults present smaller contributes than the elderly (5.2% in men and 2.0% in women).
For individuals aged 15 year-old or more, an elevated alcohol consumption (12-36 g/day for women and 24-60 g/day for men) was estimated in 5.6% of women and 18.5% of men. A very high alcohol consumption level (>36 g/day for women and >60 g/day for men) was estimated in 2.9% of women and 7.3% of men.
20.9% 29.6% 11.8% 59.7% 18.4% 22.0% 21.8% 30.7% 12.4% 32.9% 21.7% 19.4% 32.6% 29.5% 35.8% 7.4% 37.7% 16.9% 24.7% 10.2% 40.0% 22.3% 41.7% 0% 20% 40% 60% 80% 100%
Total Female Male Adolescents Adults Elderly Never ≤1day/week ≥2day/week Daily
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SUMMARY OF MAIN RESULTS
In comparison with the Portuguese Food Wheel guide recommendation, the Portuguese population is consuming proportionally more 12% of “meat, fish and eggs” and 6% of “dairy products”, but less “vegetables” (-9%), fruit (-7%) and legumes (-2%).
More than half of the Portuguese population (56%) does not meet the World Health Organization recommendation to consume more than 400g/day of fruit and vegetables (equivalent to 5 or more servings per day). The inadequacy is higher in children and adolescents, of whom 72% and 78% do not meet the recommendations. Azores (70.9%) and Madeira (67.7%) are the regions with the highest inadequacies, followed by the North (51.8%) and Centre (51.4%).
The daily consumption of processed meat higher than 50g is observed in 6.3% of the population (5.7% in children, 11.6% in adolescents, 7.1% in adults and 1.0% in the elderly) and a consumption higher than 100g of red meat is observed in 22.5% (16.3% in children, 32.3% in adolescents, 25.5% in adults and 9.0% in the elderly).
The daily consumption of soft drinks or nectars (≥220 /day) is 18%, and this prevalence is higher in adolescents (42% in total, 34% in girls and 51% in boys). The contribution of soft drinks to this percentage is 14% (34% in adolescents). Among adolescents who consume soft drinks, 25% drinks approximately two servings of soft drinks per day.
The mean consumption of alcoholic beverages is higher in men (249 g/day) than in women (44 g/day), and higher among the elderly men (350 g/day) compared to adult men (234 g/day). The average consumption among consumers is 340 g/day in men and 100 g/day in women. Still 5% of the elderly men drinks more than 1 litre (1142g) of alcoholic beverages per day, and in the adults the consumption is 981 g. Wine is the most consumed drink, but considering the consumption only among consumers, beer has a higher mean intake.
Among the population aged 15 years or older, 8.5% of women and 25.8% of men consume alcohol at levels considered high or excessive (>12 g/day in women and >24 g/day in men).
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2.
Nutrients
Intake
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This chapter presents data on nutrient intake of the Portuguese population, by sex, age group and region, as well as the prevalence of macro and micronutrient intake inadequacy and the foods that are the main contributors of that intake. Methodological notes on the estimation of nutritional intake and on the assessment of inadequacy prevalence can be found in Appendix 1.
2.1. Energy and Macronutrients
Tables 2.1 to 2.3 and figures 2.1 to 2.3 present the estimated intake of total energy and macronutrients of the Portuguese population, as well as their description by sex, age group, region and educational level, after adjusting for the within-person variability of dietary intake, estimated by the two dietary reporting days.
For all population, the average energy intake is 1910 kcal/day (1635 kcal/day in women and 2228 kcal/day in men) (table 2.1). Average contributions to the daily total energy intake (TEI) were 19.9% from protein, 46.6% from carbohydrates and 31.4% from fat, also accounting for the contribution of alcohol to the TEI. The contribution of carbohydrates is higher in children and adolescents (51.2% and 49.1%, respectively) and the contribution of fat is higher in adolescents (32.4%) but lower in the elderly (29.4%) (figure 2.1).
In the population aged 15 year-old or over, the analysis of the foods that contribute to the total energy intake, by age and sex (figure 2.2), shows that the average contribution of alcohol to daily energy intake is higher in men than in women, and is particularly high in the elderly (9.9%) and adults (5.2%).
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Table 2.1. Daily intake of the total energy and macronutrients, for the all population and by sex (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population.
Total Women Men Mean Median (P25-P75) Mean Median (P25-P75) Mean Median (P25-P75) Energy (kcal) 1910 1855 (1516-2245) 1635 1606 (1349-1891) 2228 2186 (1812-2601) Protein (%TEI) 19.9 19.7 (17.7-21.8) 19.9 19.7 (17.8-21.9) 18.0 17.7 (15.8-19.9) Carbohydrate (%TEI) 46.6 46.7 (42.3-51.0) 48.0 48.1 (43.9-52.1) 45.1 45.1 (40.6-49.7) Sugars (%TEI) (a) 18.5 18.0
(14.6-21.8) 19.9
19.5
(16.3-23.0) 17.1
16.4 (13.0-20.3) Free sugars (%TEI)(b) 7.5 6.6
(4.1-9.9) 7.8 7.1 (4.7-10.2) 6.8 6.0 (3.6-9.1) Fibre (g) 17.8 17.2 (13.7-21.2) 16.3 15.9 (12.9-19.2) 19.4 18.9 (15.0-23.2) Total fat (%TEI) 31.4 31.3
(27.9-34.9) 31.9
31.8
(28.3-35.3) 30.0
29.9 (26.5-33.3) Saturated fatty acids
(%TEI) 10.6 10.2 (8.5-12.3) 10.7 10.4 (8.6-12.4) 10.1 9.7 (8.0-11.7) Monounsaturated fatty acids (%TEI) 12.7 12.5 (10.7-14.4) 12.7 12.6 (10.8-14.5) 12.5 12.3 (10.6-14.2) Polyunsaturated fatty acids
(%TEI) 5.2 5.0 (4.3-5.9) 5.3 5.2 (4.4-6.1) 4.8 4.6 (3.9-5.4)
Trans fatty acids (%TEI) 0.4 0.4
(0.3-0.5) 0.4
0.4
(0.3-0.5) 0.4
0.3 (0.3-0.5)
P25-P75: percentile 25-75; TEI: daily total energy intake (a) Sugars: total of monosaccharides and disaccharides
(b) Free sugars: sugars added to foods by industry, catering or consumers, besides sugars naturally present in honey, syrups and fruit juices
(c) The alcohol estimation was performed in individuals aged 15 years-old or older
The mean national intake of sugars (mono and disaccharides) is 84 g/day (median 80 g/day: P25-P75 = 62-103), contributing, on average, to 18.5% of the TEI. This contribution is higher in children (24.9%) and adolescents (20.2%). Regarding the consumption of free sugars (sugars added to foods by industry, catering or consumers, besides sugars naturally present in honey, syrups and fruit juices), the national average intake corresponds to 35 g/day (median 30 g/day: P25-P75 = 17-47), contributing, on average, to 7.5% of the TEI. This contribution is higher in the adolescents’ group with 10.5% and in the age group of children with 9.6%.
37 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
The intake of fibre is significantly higher in men than in women, also showing a significant increase with age.
At national level, the saturated fatty acids contribute with 10.6% for the TEI, monounsaturated fatty acids with 12.7% for the TEI, while polyunsaturated fatty acids contribute with 5.2%. When compared to adults, children and adolescents present a greater percentage contribution of saturated fatty acids to the TEI (12.1% and 12.0%, respectively), with mean intakes of 21.9 g/day and 27.5 g/day, respectively. On the other hand, the elderly is the age group with the lowest percentage of contribution of saturated fatty acids to the energy intake (9.1%).
Table 2.2. Daily intake of total energy, macronutrients and fibre, by age group (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population.
Children
(<10 years) (10-17 years) Adolescents (18-64 years) Adults (65-84 years) Elderly Mean (P25-P75) Median Mean (P25-P75) Median Mean (P25-P75) Median Mean (P25-P75) Median
Energy (kcal) 1646 (1243-2012) 1614 2043 (1517-2072) 1781 1962 (1568-2292) 1904 1760 (1401-2060) 1706
Protein (%TEI) 18.6 (16.5-20.5) 18.4 19.8 (17.7-21.7) 19.6 20.2 (18.1-22.1) 19.9 19.5 (17.4-21.4) 19.3 Carbohydrates
(%TEI) 51.2 (47.2-55.3) 51.3 49.1 (45.0-53.3) 49.2 45.7 (41.5-50.1) 45.9 46.7 (42.5-51.0) 46.8 Sugars (%TEI) (a) 24.9 24.2
(19.4-28.6) 20.2 (16.3-23.6) 19.8 17.9 (14.3-21.1) 17.5 17.6 (14.0-20.7) 17.2 Free sugars
(%TEI)(b) 9.6 (5.9-12.5) 8.8 10.5 (6.8-13.5) 9.8 7.5 (4.4-9.8) 6.7 5.0 (2.6-6.6) 4.3
Fibre (g) 14.1 (10.4-17.3) 13.6 16.8 (13.0-20.0) 16.3 18.1 (14.1-21.5) 17.5 18.5 (14.4-21.9) 17.9
Total fat (%TEI) 31.5 (28.0-34.9) 31.4 32.4 (28.8-35.7) 32.2 31.8 (28.3-35.2) 31.7 29.4 (26.0-32.7) 29.3 Saturated fatty
acids (%TEI) 12.1 (9.8-13.9) 11.7 12.0 (9.8-13.8) 11.6 10.7 (8.6-12.3) 10.3 9.1 (7.4-10.4) 8.8 Monounsaturated
fatty acids (%TEI) 12.3 (10.5-14.0) 12.1 12.7 (10.7-14.4) 12.5 12.9 (10.9-14.6) 12.7 12 (10.2-13.7) 11.8 Polyunsaturated
fatty acids (%TEI) 4.8 (4.0-5.5) 4.7 5.1 (4.2-5.8) 4.9 5.3 (4.4-6.1) 5.2 4.9 (4.1-5.6) 4.8
Trans fatty acids
(%TEI) 0.5 (0.3-0.6) 0.5 0.5 (0.4-0.6) 0.5 0.4 (0.3-0.5) 0.4 0.3 (0.2-0.4) 0.3 P25-P75: percentile 25-75; TEI: daily total energy intake
(a) Sugars: total of monosaccharides and disaccharides.
(b) Free sugars: sugars added to foods by industry, catering or consumers, besides sugars naturally present in honey, syrups and fruit juices
38 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Figure 2.1. Percentual contribution of macronutrients for the total energy intake (including energy from alcohol), at national level, by sex and by age group (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population.
Figure 2.2. Percentual contribution of macronutrients and alcohol for the total energy intake in individuals aged 15 years-old or more, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population.
19.9% 19.9% 18.0% 18.6% 19.8% 20.2% 19.5% 46.6% 48.0% 45.1% 51.2% 49.1% 45.7% 46.7% 31.4% 31.9% 30.0% 31.5% 32.4% 31.8% 29.4%
National Female Male Children
(<10 years) (10-17 years)Adolescents (18-64 years)Adults (65-84 years)Elderly Protein (%TEI) Carbohydrate (%TEI) Total Fat (%TEI)
19.4% 20.2% 19.5% 18.1% 18.2% 17.5% 48.8% 47.2% 49.3% 49.1% 44.1% 44.2% 32.4% 32.3% 30.3% 31.2% 30.3% 27.7% 0.5% 2.0% 3.2% 0.5% 5.2% 9.9% 0% 20% 40% 60% 80% 100% Adolescents (15-17 years) Adults (18-64 years) Elderly (65-84 years) Adolescents (15-17 years) Adults (18-64 years) Elderly (65-84 years) Female Male
39 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
At the regional level (figure 2.3), it is possible to observe significant differences in energy intake, with Alentejo being the region with the lowest average energy intake (1895 kcal/day), and Madeira and Azores with the highest energy intakes (1915 and 1913 kcal/day, respectively). The distribution of macronutrients also presents some differences by region; the Autonomous Region of Madeira is the region with the highest percentage contribution of carbohydrates to the total energy intake (50.3%), the lowest contribution of fat (27.9%) and the lowest protein contribution (27.9%). The Central region has the largest contribution of fat (32.2%) and the lowest contribution of carbohydrates (44.8%) for the total energy intake.
Figure 2.3. Spatial distribution (by NUTS II region) of the mean energy intake (kcal / day) (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population.
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Table 2.3 presents the nutritional intake according to the educational level. Overall, energy intake is higher among the more educated. In this group, there is also a higher intake of protein and carbohydrates and a lower intake of saturated and trans fatty acids. For the group with higher education, a higher intake of fibre and lower free sugars were observed, compared to the less educated ones.
Table 2.3. Daily intake of total energy and macronutrients by educational level (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population.
None, 1st and 2nd cycle 3rd cycle and high school Higher education
Mean (P25-P75) Median Mean (P25-P75) Median Mean (P25-P75) Median
Energy (kcal) 1846 (1430-2197) 1786 1938 (1536-2281) 1883 1899 (1567-2195) 1864 Protein (%TEI) 19.4 (17.6-21.1) 19.3 17.9 (15.8-19.8) 17.7 17.9 (15.9-19.8) 17.8 Carbohydrates (%TEI) 47.1 (42.0-52.2) 47.1 45.8 (41.8-49.9) 45.9 45.9 (42.1-49.9) 46.1 Sugars (%TEI) (a) 18.1 17.2
(13.5-21.7) 18.9 (15.1-22.1) 18.4 19.1 (15.6-22.0) 18.6 Free sugars (%TEI)(b) 7.9 6.7
(3.9-10.7) 7.8 7.0 (4.4-10.3) 7.0 6.3 (4.0-9.3) Fibre (g) 16.6 (12.6-19.9) 16.0 17.3 (13.6-20.7) 16.9 18.8 (14.7-22.3) 18.3 Total fat (%TEI) 29.7 (26.3-32.9) 29.6 30.1 (26.9-33.1) 30.0 30.2 (27.0-33.4) 30.2 Saturated fatty acids
(%TEI) 9.4 (7.8-10.8) 9.2 9.8 (8.3-11.2) 9.7 9.8 (8.3-11.2) 97 Monounsaturated
fatty acids (%TEI) 11.7
11.6 (10.0-13.2) 12.2 12.0 (10.5-13.6) 12.2 12.1 (10.5-13.7) Polyunsaturated
fatty acids (%TEI) 4.8 (3.9-5.4) 4.6 4.7 (3.9-5.4) 4.6 5.0 (4.0-5.8) 4.8
Trans fatty acids
(%TEI) 0.3 0.3 (0.2-0.4) 0.4 0.4 (0.3-0.5) 0.4 0.4 (0.3-0.5)
P25-P75: percentile 25-75; TEI: daily total energy intake (a) Sugars: total of monosaccharides and disaccharides.
(b) Free sugars: sugars added to foods by industry, catering or consumers, besides sugars naturally present in honey, syrups and fruit juices
41 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
The guidelines proposed by EFSA for the European population were used to calculate the inadequacy of macronutrient intake (17). The inadequacy of macronutrient intake of the Portuguese population is presented in figure 2.4, by sex, and additionally by age group in table 2.4.
Figure 2.4. Prevalence of (in)adequacy of macronutrient intake, by sex (IAN-AF 205-2016), weighted for the distribution of the Portuguese population.
More than half of the population (57.1%) has a daily intake of protein between 1 and 2 g/kg of body weight; around 10% of women and 15.7% of men exceed the intake of 2 g/kg of body weight. An intake below 1 g/kg of body weight occurs in 39.3% of women and 22.6% of men. Taking into consideration age, the elderly have a high prevalence of low protein intake (48.6%) and, on the contrast, about 83% of the children exceed the 2g of protein per kg of weight. The prevalence of protein intake inadequacy by deficit, taking into account the mean needs by age and sex established by the EFSA, is higher in elderly women (13.8%), adult women (6.5%) and elderly men (5.1%).
39.3% 22.6% 30.8% 49.6% 3.0% 4.6% 50.9% 61.7% 67.2% 49.2% 70.4% 79.9% 9.8% 15.7% 2.0% 1.2% 26.6% 15.5% 0% 20% 40% 60% 80% 100%
Female Male Female Male Female Male Protein Carbohydrate Total Fat Below recommendations According to recommendations Above recommendations
42 National Food, Nutrition and Physical Activity Survey, IAN-AF 2015–2016 | Summary of Results
Table 2.4. Prevalence of inadequate intake of macronutrients, at national level, by sex and age group (IAN-AF 2015-2016), weighted for the distribution of the Portuguese population.
Total Women Men (<10 years) Children (10-17 years) Adolescents (18-64 years) Adults (65-84 years) Elderly Protein < 1 g/kg weight 30.2% 39.3% 22.6% 0.2% 3.8% 31.7% 48.6% > 2 g/kg weight 12.7% 9.8% 15.7% 83.2% 35.2% 5.3% 1.5% Carbohydrates < 45 % TEI 40.1% 30.8% 49.6% 15.7% 24.9% 44.7% 38.7% > 60 % TEI 1.6% 2% 1.2% 6.9% 3.5% 1% 1.4% Free sugars > 10 % TEI 24.3% 26.3% 20.1% 40.7% 48.7% 24.1% 7.4% Total fat < 20 % TEI 3.4% 3% 4.6% 34.2% 0.5% 0.7% 2.4% > 35 % TEI 23.6% 26.6% 15.5% 16.8% 29.6% 26.3% 13.3% Saturated FA > 10 % TEI 52.9% 55.5% 45.4% 73.0% 71.9% 54.4% 30.7% Trans FA > 1 % TEI 0.4% 0.4% 0.4% 1.6% 1.4% 0.2% 0% TEI – Total energy intake; FA - Fatty Acids
The overall prevalence of inadequate intake of carbohydrates is 41.7% (40.1% by deficit), being higher in men and in adults. Around one quarter (24.3%) of all population has a consumption of free sugars higher than 10% of the TEI; adolescents (48.7%) and children (40.7%) have the highest intakes.
Only 3.4% of the Portuguese population have an intake of fat below recommendations, although in children the prevalence of inadequacy by deficit is of 34%. The intake of fat above the recommendations occurs in 23.6% of the entire population. Around half of the Portuguese population (53%) exceeds the intake of 10% of TEI from saturated fatty acids. The highest intake is observed in children (73%) and adolescents (72%). Also, children and adolescents present the highest prevalence of inadequacy for trans fatty acids, although it is relatively low (1.6% and 1.4%, respectively). The prevalence of inadequacy of trans fatty acids (> 1% of TEI) for the entire population is only 0.4%.
